Nursing Care Plan for Pulmonary Embolism

Pulmonary embolism (PE)

A pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can cause

• Permanent damage to the affected lung
• Low oxygen levels in your blood
• Damage to other organs in your body from not getting enough oxygen

If a clot is large, or if there are many clots, pulmonary embolism can cause death.

Signs and Symptoms

• dyspnoea - suddenly and there is at 90% of cases
• pleuritic chest pain
• haemoptisis
• fainting
• tachycardia more than 100/menit
• tachipnoe more than 20/menit
• fever

Threat Signs of Life:
Symptoms of Pulmonary embolism:

• severe dyspnea
• chest pain
• increased venous pressure
• there is evidence of right heart failure
• hypotension
• shock

Assessment for Pulmonary Embolism

Assessment of the ABCD approach

Airway

• Assess and maintain airway
• Perform head tilt, chin lift if necessary
• Use this tool to the airway if necessary
• Consider referring to the anesthesiologist to do intubation if unable to maintain airway

Breathing

• Assess oxygen saturation using pulse oximeter, to retain more than 92% saturation.
• Give high-flow oxygen via non re-breath mask.
• Consider getting a breathing using bag-valve-mask ventilation
• Make checks to assess arterial blood gas PaO2 and PaCO2
• Assess breathing
• Perform examination of respiratory system
• Listen to the sound of the pleura
• Make checks thoracic images - may be normal, but look for:
• Evidence of a wedge shaped shadow (infarct)
• Linear atelectasis
• Effuse pleural
• Hemidiaphragm increased
• If the clinical signs show the presence of pulmonary embolism, ventilation perfusion scan done (VQ) or CT pulmonary angiogram (CTPA) in accordance with local policy

Circulation

• Assess heart rate and rhythm, the possibility of sound gallops
• Assess increased JVP
• Record blood pressure
• ECG examination may show:
• Sinus tachycardia
• The existence of S1 Q3 T3
• Right bundle branch block (RBBB)
• Right axis deviation (RAD)
• P pulmonale
• Perform IV access
• Perform a complete blood

Disability

• Assess level of consciousness by using AVPU
• Decreased awareness of incoming patients showed early signs of extreme conditions and require immediate medical attention and requires treatment in the ICU.

Exposure

• Always examine the possibility of using a test Pulmonary embolism, if the patient is stable and health history examinations do other physical examination.
• Do not forget to check for signs of DVT

Risk Factors of Pulmonary embolism

• DVT exist in 50% of patients
• Previous surgery
• Previous trauma
• Immobilization for various reasons
• Malignancy
• Patients taking oral contraceptives
• Patients received hormone therapy
• Long gestation
• Obesity
• Patients get Estregen Selective Receptor Modulator therapy (SERM)
• Hyperviskositas Syndrome
• Childbed
• Nephrotic syndrome
• Antithrombin III deficiency
• Deficiencies of protein C and S
• Lupus anticoagulant

Nursing Care Plan for Pulmonary Embolism